Health
Opinion: How California Can Blunt the Impact of Medicaid Cuts
By Josh Leonard
The country’s Medicaid system is about to face sweeping cuts due to the passage of H.R. 1. The federal bill enacts nearly $900 billion in reductions over the next decade and creates new reporting rules and administrative traps which guarantees that many eligible people will lose their coverage, not because they fail to qualify, but because they fail to navigate the red tape.
State leaders estimate that the federal Medicaid cuts will force 3.4 million Californians out of our version of the program, known as Medi-Cal. But we do not have to sit idly by and wait for the fallout. In fact, states and communities still hold real power to blunt the worst outcomes and protect coverage for millions.
State leaders must set up a first line of defense against devastating health care cuts. National projections often assume states will implement the law in ways that cause more people to lose coverage. California is different. For decades, the state has expanded access and invested in a stronger safety net. Our policymakers are unlikely to embrace the spirit of these cuts, even if bound by their letter.
That means California can implement the law in the least harmful way: creating broad exemptions, simplifying paperwork and deploying technology to reduce administrative friction. The state can work to preserve coverage wherever possible.
Local organizations are essential partners in this effort. I see this firsthand as CEO of East Bay Agency for Children (EBAC), an Alameda County nonprofit that reduces the impact of trauma and social inequities. Because so many people lose health coverage not from ineligibility but from paperwork barriers, community-based groups, providers and health plans can make a decisive difference. At EBAC, we already partner with county agencies to provide case management and outreach, helping families navigate renewals and document exemptions, so they can stay connected to care.
We know this works. When paperwork requirements returned for Medi-Cal participants after the COVID era, California mobilized at scale. Counties and community organizations partnered with health plans to flag at-risk households, send multilingual reminders, provide technical support for online renewals and even make in-person visits. Regulators eased the process by simplifying forms, extending deadlines and allowing exemptions. Together, these efforts helped prevent eligible families from losing coverage.
That playbook is directly relevant now. Outreach workers, case managers and technology platforms can again be leveraged to help families meet new requirements and stay insured. If we act with the same urgency and coordination as during the pandemic, California can keep bureaucratic hurdles from turning into catastrophic losses and show that even when federal policy is designed to shrink coverage, states and communities can protect families.
Make no mistake, we’re in for a big fight. The federal Congressional Budget Office projects that there will be 10.5 million fewer Medicaid enrollees by 2034. Nearly half of those losses will stem not from ineligibility but from system barriers. Yes, the risks are serious, but disaster is not inevitable. The question is not whether harm can be done, but how states and local partners choose to respond.
The stakes are high. But so is California’s capacity to respond. The choices policymakers, agency administrators and organizational leaders make today will determine whether millions remain connected to care or fall through the cracks.
Josh Leonard is the CEO of the East Bay Agency for Children in Alameda County.
This article first appeared on California Health Report and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
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Previously Published on calhealthreport.org with Creative Commons License
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